03-30-2007, 05:48 AM
A 39-year-old woman presents to the emergency department 9 days after delivering a full-term healthy baby by caesarean section. She complains of shortness of breath that started the previous day, has progressively worsened, and is accompanied by a cough that is minimally productive of white-pink sputum. She denies chest pain, palpitations, fever, or chills. Physical examination shows she is severely distressed and tachypneic. Vital signs are: heart rate, 120 beats/min; BP, 230/120 mm Hg; temperature, 37°C; respiratory rate, 34 breaths/min. She has bilateral diffuse crackles in both lung fields. Cardiac sounds are normal, and no murmurs are heard. She has 2+ pedal edema bilaterally. Chest x-ray reveals bilateral diffuse alveolar infiltrates. An arterial blood gas measurement on 50% Venturi mask shows: pH, 7.17; PaCO2, 77 mm Hg; PaO2, 54 mm Hg. Urinalysis reveals no red blood cells (RBCs) per high-power field (HPF) on microscopy, 3 WBCs per HPF on microscopy, and 3+ protein on dipstick testing. What is the most likely diagnosis?
A. Fat embolism leading to adult respiratory distress syndrome (ARDS)
B. Postpartum cardiomyopathy leading to pulmonary edema
C. Preeclampsia leading to ARDS
D. Preeclampsia leading to pulmonary edema
E. Postpartum sepsis leading to ARDS
A. Fat embolism leading to adult respiratory distress syndrome (ARDS)
B. Postpartum cardiomyopathy leading to pulmonary edema
C. Preeclampsia leading to ARDS
D. Preeclampsia leading to pulmonary edema
E. Postpartum sepsis leading to ARDS